Infection in residual periodontitis sites during the period of supportive periodontal therapy (SPT). In this study, we conducted a questionnaire survey to investigate the frequencies and backgrounds of scaling and root planing (SRP) performed in patients within 1 year of SPT. Analysis of the patient profile revealed a large number of patients with residual periodontitis sites at the beginning of SPT. During the SPT period, 30 % of the patients received SRP and 64.3 % of the SRP cases showed persistence of sites with a probing pocket depth (PPD) of ≥ 4 mm. To confirm the risk of disease progression and the necessity for preventive SRP in the early of SPT period, we examined the changes in the periodontopathogen profile in subgingival plaque samples. Obtained results showed that SPT without using SRP under anesthesia was not able to prevent a re-increase of Porphyromonas gingivalis. Especially, the incidence of isolation of this species at sites with a PPD of ≥ 4 mm was restored to a level close to that before the start of the periodontal treatment. These sites harboring the risk of future disease progression appeared to need SRP under anesthesia during the SPT period (at an average of 4.5 months). Nihon Shishubyo Gakkai Kaishi (J Jpn Periodontol) 49 : 20-26,2007.

View full abstract

Bone sialoprotein (BSP) is a phosphorylated and sulfated noncollagenous protein that has been shown to have the ability to mediate cell attachment through an Arg-Gly-Asp (RGD) sequence and to bind hydroxyapatite through polyglutamic acid sequences. The restricted distribution and temporal changes in the expression of BSP mRNA and the ability of BSP to nucleate hydroxyapatite crystals indicate the potential role of this protein in the initial mineralization of bone. Androgens are steroid hormones that are essential for skeletal development. The androgen receptor (AR) is a transcription factor and a member of the steroid receptor superfamily that plays an important role in male sexual differentiation and prostate cell proliferation. In this study, we analyzed the effects of androgens and the AR on the expression of the BSP using osteoblast-like cells (ROS17/2.8 cells). Increase in AR protein levels was observed with androgen receptor (AR) overexpression in ROS17/2.8 cells. The BSP mRNA levels were also increased by AR overexpression. However, the endogenous and overexpressed BSP mRNA levels were not affected by DHT (10^-8M, 24 h). While the luciferase activities in all constructs, including a short construct (nts-116 to +60), were increased by AR overexpression, the basal and luciferase activities enhanced by AR overexpression were not affected by DHT(10^-8M, 24 h). The effect of AR overexpression was abrogated by 2 bp mutations in either the cAMP response element (CRE) or the activator protein 1/glucocorticoid response element (AP1/GRE). Gel shift analyses showed that AR overexpression increased binding to the CRE and AP1/GRE elements. Notably, the CRE-protein complexes were supershifted by phospho-CREB antibody, and CREB and AR antibodies disrupted the formation of the complexes. The AP1/GRE-protein complexes were supershifted by c-Fos antibody, and c-Jun and AR antibodies disrupted the formation of the complexes. These studies demonstrate that AR stimulates BSP gene transcription by targeting the CRE and AP1/GRE elements in the promoter of the rat BSP gene. Nihon Shishubyo Gakkai Kaishi (J Jpn Periodontol) 49 : 27-36,2007.

View full abstract

This study examined whether the initial treatment yielded functional improvement of the occlusal force and improvement of periodontal pockets. The subjects of this study were 20 patients (11 males and 9 females) diagnosed to have chronic periodontitis. Based on the treatment modality used, the subjects were divided into two groups. The first group was treated by 0.2% ethacridine lactate (acrinol^®) irrigation using a syringe and supragingival scaling. The second group underwent root planning. The changes in the clinical parameters were examined, and the changes of the occlusal force and occlusal contact area were measured using a dental prescale^®. These parameters were also compared between the anterior and molar teeth.The results obtained were as follows:1. significant improvement of the clinical parameters was observed in both groups.2. The occlusal force increased significantly and the occlusal contact area decreased significantly.3. There were significant differences in the change of tooth mobility and changes of the occlusal force and occlusal contact area between the anterior and molar teeth. These results suggested that the occlusal functions improved with improvement in the condition of the periodontal tissues in response to the initial treatment, and that there was a difference in the therapeutic response between the anterior and molar teeth. Nihon Shishubyo Gakkai Kaishi (J Jpn Periodontol) 49 : 37-46,2007.

View full abstract

Severe chronic periodontitis is an inflammatory disease affecting the periodontium, characterized by progressive destruction of the tooth attachment and bone loss. This report describes the management of a patient with severe chronic periodontitis, who was treated by initial therapy followed by periodontal surgery. A 35-year-old male presented with clinical and radiographic evidence of severe loss of attachment and bone resorption. During initial therapy, minor orthodontic movement was performed to recover the biologic width lost due to subgingival caries. The periodontal surgical procedure consisted of an apically positioned flap surgery with osseous resection. After healing, permanent fixed bridges and crown restorations were fabricated to stabilize the mobile teeth. The treatment resulted in improvement of the alveolar bone level with minimal postoperative changes in the attached gingiva. A two-year follow up confirmed successful disappearance of the destructive lesions. Nihon Shishubyo Gakkai Kaishi(J Jpn Soc Periodontol)49 : 47-54,2007.

View full abstract

This paper reports a case of nifedipine-induced gingival overgrowth that was successfully treated by initial preparation without surgical therapy. A 54-year-old man visited our clinic with the chief complaint of gingival bleeding. He had been taking a calcium-channel blocker (nifedipine) for 4 years and had recently observed gingival overgrowth. This patient also had chronic periodontitis, with periodontal pockets as deep as with a total PD of 1,482 mm. In addition,progressive resorption of the alveolar bone was observed. Nevertheless, initial preparation was performed, in response to which, the gingival overgrowth improved significantly, and the total PD of the periodontal packets reduced to 39 %. During the maintenance period, the patient continued to take the calcium-channel blocker (amlodipine besylate), however, no recurrence was observed. By 5 years later , the total PD of the periodontal pockets had reduced to 27%. Gingival overgrowth associated with drug intake maybe caused not only as a side effect of the drugs, but also by poor oral hygiene and gingivitis. Furthermore, it is suggested that drug-induced gingival overgrowth could be prevented by proper initial preparation and maintenance therapy. Nihon Shishubyo Gakkai Kaishi (J Jpn Soc Periodontol) 49 : 55-60,2007.

View full abstract

Multiple risk factor clustering syndrome (diabetes, dyslipidemia, hypertension, and obesity) is characterized by an increased risk of ischemic heart events, such as myocardial infarction. In this case report, we describe the clinical course of a patient suffering from severe periodontitis with the multiple risk factor clustering syndrome, whose blood glucose control was improved following periodontal treatment, but who developed myocardial infarction and stroke, and then heart failure, during supportive periodontal treatment(SPT). The purpose of the present case report is to discuss the influence of periodontal disease on the systemic health in such subjects based on our clinical observations. The patient was a 62-year old woman. Who had been suffering from type 2 diabetes, dyslipidemia, hypertension and presented to us with severe periodontitis. At her first visit to us, her glycemic control was very poor. The serum IgG antibody titer to Porphyromonas gingivalis (Pg) was higher than the mean titer in healthy subjects plus two standard deviations. Her body mass index was 21.3 kg/m². There was no evidence of diabetic complications at this time. Based on our examinations, we diagnosed her as having severe periodontitis associated with insulin resistance (diabetes). Our treatment goal was thorough removal of infection from the periodontal pockets. Following treatment, the antibody titer to Pg, and the glycosylated hemoglobin value decreased, as other clinical parameters improved. However, the subject developed acute myocardial infarction during the SPT period, which was followed by relapse of the periodontitis and uncontrolled hyperglycemia. In this case, it appeared that the clustering of risk factors such as type 2 diabetes, hypertension, dyslipidemia and severe periodontitis precipitated the myocardial infarction. Based on this experience, it is suggested that prevention of such risk factors, including periodontal disease, is more important in such high-risk subjects. Nihon Shishubyo Gakkai Kaishi (J Jpn Periodontol) 49 : 61-70,2007.

View full abstract

Recent studies have suggested that the use of platelet-rich plasma (PRP) combined with bone graft materials may be effective in the treatment of periodontal intrabony defects in humans. However, no clinical studies of periodontal regeneration therapy using PRP in combination with autogenous bone, containing the characteristic properties of osteoproliferation, osteoinduction and osteoconduction have been reported.The aim of this present study was to evaluate platelet-rich plasma (PRP) combined with autogenous bone grafts for the treatment of intrabony defects in humans. A total of 22 intrabony osseous defects in 17 non-smoking subjects with chronic periodontitis were included in this study. Clinical and radiographic measurements were obtained at baseline and at the 6-month evaluation. Statistically significant changes in the 6-month evaluation results as compared with the baseline were observed, as follows : probing depth (PD) reduction : 3.20±1.28 mm (p < 0.01) ; clinical attachment level (CAL) gain : 2.52±1.08mm (p < 0.01) ; vertical bone defect : 45.3±9.3% (p < 0.05). The results of this study suggest that the use of PRP combined with autogenous bone grafts is effective for periodontal regeneration therapy. Nihon Shishubyo Gakkai Kaishi (J Jpn Periodontol) 49 : 71-76,2007.

View full abstract